Medical problems due to preventable causes (accidents,
lack of preventive care, drug and alcohol abuse, etc).
Some relatively easy "technical" fixes:
Standard forms (for claims, prescriptions, charts, patient history, lab results, etc)
used by all insurance companies, doctors, labs, hospitals, pharmacies, etc.
This would reduce costs and errors for everyone.
Standard number-codes for prescription drugs, which must be
written on prescription forms and patient charts (in addition to
the info already written there today). This would
reduce errors.
Absolutely free care and supplies for simple, cheap things that prevent
more expensive complications later: vaccinations, condoms, needles, blood-pressure screening,
diabetes screening.
Hard / controversial / Draconian fixes:
No insurance coverage for very expensive
procedures (heart transplant, heart-lung transplant,
extremely premature birth, etc). The money used by one of these
procedures would pay for preventive or routine care for a thousand people.
No insurance coverage for fairly expensive
procedures as a result of self-inflicted problems
(liver transplants for alcoholics, cancer operations for smokers, etc).
The money used by one of these
procedures would pay for preventive or routine care for a hundred people.
Taking a step back to look at the bigger picture:
I once attended a talk by C. Everett Koop (after he left office) where he
said something like:
"No one ever designed the US health-care system. It just grew, haphazardly."
Even thinking selfishly, we can't have a totally free-market system, because that would lead to an
environment we don't want: poor sick people dying on the streets, poor children with
horrible avoidable diseases, epidemics starting with the poor and spreading to everyone.
That's why hospital emergency rooms treat everyone today: those of us who can pay
don't want what would result from a no-pay-go-away policy. That's also why we
have food-banks and homeless shelters and Social Security and other programs: not just because it's
a morally right thing to do, but to benefit the non-poor too. We wouldn't want
to live in a totally-privatized, no-safety-nets society; it would be ugly.
Parts of a health-care system:
Participants / patients (may be voluntary, universal, and grouped or not).
Payers (may be single-payer/government, employers and/or individuals).
Insurance companies (aggregate money and risks).
Service providers (hospitals, clinics, doctors, nurses, home care workers, consultants, educators).
Services (always rationed, in some way: by money, long waiting lists, limited
facilities, or explicit policy by insurance plan or provider).
Material providers (pharmaceutical companies).
Some linkages:
More participants (especially universal) and fewer payers (especially single-payer) can lead to
economies of scale in purchasing materials (drugs) because of more leverage when negotiating
with the drug companies.
Fewer payers (especially single-payer) can lead to
reduced administrative overhead because of fewer forms, fewer insurance companies to contact,
fewer policies to understand.
More participants (especially universal) can lead to
economies of scale in service providers (bigger hospitals, more clinics).
The problem with a "single-something" entity is that if something goes wrong with that entity,
you're stuck; there are no alternatives. If the government is the single-payer, and
they start shortchanging the providers (as happened with the British NHS under Margaret Thatcher),
the system degrades and only the rich have any alternative to use. When I visited
Vancouver BC Canada in the early 90's (I think), there was a doctor's strike throughout
the entire province of British Columbia, a scary situation. So "single-something" is
not without risks.
Having some people go uninsured is bad because:
Uninsured sick people can infect insured people.
Uninsured people let easily-treated conditions mature into expensive emergencies later,
and we all pay for those emergencies.
Uninsured people can have damaged babies,
and we all pay for lifetime care of those babies.
Uninsured people go bankrupt when they have a major medical emergency,
and we all pay for those bankrupcties.
Part of the current system is employment-based insurance, which tends to
discourage people from changing jobs, because they'd have to change
insurance too.
A universal-participants, single-payer system would tend to reduce the
amounts of money spent by drug companies on lobbying and advertising,
reducing costs for everyone.